Test 1. Part 2 Flashcards
1
Q
Fifth Metatarsal - Base - Dorsal surface - 3 attachments:
A
• 1) peroneus tertius {T} Note: also inserts on the dorsal surface of the shaft • 2) dorsal cuboideometatarsal ligament {R} • 3) dorsal intermetatarsal ligament (to 4th metatarsal) {L}
2
Q
Medial Cuneiform - Small oval shaped facet
A
-Lateral surface -anteriorly – for base of second metatarsal
3
Q
on the first digit the plantar plate is attached to
A
the deep transverse ligament on the lateral side only.
4
Q
What is the keystone of the medial arch?
A
Talus
5
Q
Retinacula of the Ankle Superior Extensor Retinaculum - Attaches (Medially)
A
Medially, it attaches to the anterior crest (border) of the tibia and to the medial malleolus
6
Q
The superior extensor retinaculum binds
A
The superior extensor retinaculum binds the tendons of the extensor digitorum longus, extensor hallucis longus, peroneus tertius, and the tendon of the tibialis anterior in its synovial sheath.
7
Q
Intermediate Cuneiform -what forms the base
A
Dorsal surface
8
Q
Navicular Plantar surface tubercle
A
o Tubercle for attachment of spring ligament –>near the middle of the plantar surface
9
Q
Talus -Trochlea articulates with
A
• Tibial plafond (inferior surface of tibia) “tibial plaform” • Medial malleolus (of tibia) • Lateral malleolus (of fibula) • Anterior (inferior) tibiofibular ligament • Inferior transverse ligament (deep portion of posterior (inferior) tibiofibular ligament)
10
Q
First Metatarsal -head -Distal (anterior) surface is
A
continuous with the plantar surface where the facets for medial and lateral sesamoid bones are located
11
Q
Talus -Lateral surface–> Lateral process
A
– inferior tapered, pointed end -This surface has a triangular facet for lateral malleolus -Superiorly the base of the triangular facet is continuous with the trochlea
12
Q
The deep fascia of the dorsum of the foot is continuous with what and attaches where?
A
The deep fascia of the dorsum is continuous with the plantar aponeurosis and attaches to the peroneal trochlea, cuboid and the tuberosity of the fifth metatarsal LATERALLY, and the navicular tuberosity, sustentaculum tali and first metatarsal MEDIALLY
13
Q
Second Metatarsal -base -Medial surface -Ligament Attachments:
A
• Lisfranc’s ligament {E}
14
Q
Ossification of Foot Bones - Phalanges
A
o Each has 2 centers: Diaphysis (shaft) Epiphysis (base)
15
Q
Navicular–> attached to the lateral and the dorsal surface
A
lateral calcaneonavicular portion of bifurcate ligament
16
Q
The extensor digitorum longus tendon of digits two, three, four and five -The central slip passes
A
distally along the dorsum of the proximal phalanx
17
Q
The extensor digitorum longus tendon of digits two, three, four and five -The central slip inserts
A
inserts on the base of the middle phalanx.
18
Q
Talus • Attaches anteroinferior to lateral malleoolar surface
A
Lateral talocalcaneal ligament
19
Q
Dorsalis Pedis terminal branches
A
at the first intermetatarsal space it divides into its two terminal branches, the deep plantar and the 1st dorsal metatarsal arteries
20
Q
Sustantaculum tali is located where
A
Calcaneus -Medial Surface
21
Q
Third Metatarsal - Base
A
o 4 articular areas (1 posterior, 1 lateral, 2 medial)
22
Q
Talus- posterior process -lateral tubercle -When ossification center fails to fuse with the rest of talus
A
lateral tubercle is anaccessory bone (called os trigonum)
23
Q
Medial Cuneiform -Posterior surface
A
Concave Articulates with navicular Facet shaped: like with the corresponding medial facet on the navicular, the shape of the facet can be triangular, pear-shaped or quadrilateral
24
Q
The bones of the medial arch are?
A
- First three metatarsals -all three cuneiforms - Navicular -calcaneus -Talus
25
Calcaneus -Lateral Surface o Third tubercle of peroneal trochlea
-present 40%-50% of time Posterior & superior to retrotrochlear eminence Attachment of calcaneofibular ligament
26
fibers of the intermediate root continue medially to form
the superomedial and inferomedial oblique bands
27
On the sole of the foot the superficial veins form
a plantar cutaneous venous arch that drains into the medial and lateral marginal veins.
28
Although the dorsalis pedis for the most part lies deep to the superficial structures of the dorsum of the foot, it is superficial enough to
demonstrate a pulse
29
Fourth Metatarsal - Base -Posterior Surface
Quadralateral facet (articulates with cuboid)
30
Talus - what blends with the neck of the Talus?
Superior surface of the Head of the Talus
31
Medial Cuneiform -Posterior surface -Articulates with what
-Navicular
32
Great Toe -- Distal Phalanx - Base
Transversely oriented, Large Deviates laterally 15 degrees from the proximal phalanx
33
Perforating Branch of Peroneal Artery
perforates the interosseous membrane just above the anterior tibiofibular ligament to gain access to the dorsal part of the foot. This perforating artery is usually very small, but can be fairly large and on occasion take over the vascular supply of the dorsal foot.
34
- Longest of metatarsals, extends more proximal than others
Second Metatarsal
35
Navicular facet that is either pear, triangular or quadrilateral shaped?
Medial facet. Part of the large articular facet on the anterior surface of the navicular. - articulates with the medial cuneiform
36
Peroneal notch
Cuboid--\> plantar edge marks the beginning of peroneal sulcus
37
Ossification of Foot Bones - Tarsal bones
o All have primary ossification center o Calcaneus: (2 centers) primary ossification center + epiphysis in posterior extremity
38
Superfiical Peroneal Nerve The intermediate dorsal cutaneous nerve
has some communication with the lateral dorsal cutaneous nerve. The intermediate dorsal cutaneous nerve divides into the 2nd & 3rd common dorsal digital nerves for intermetatarsal spaces 3 and 4. Each common dorsal digital branch, at the webbing space, divides to give rise to two dorsal digital nerves. Recall that the 10th dorsal digital nerve originates from the lateral dorsal cutaneous nerve.
39
• The long plantar ligament and cuboid form
an osseofibrous canal for the tendon of the peroneus longus.
40
1 facet that rests on the spring ligament
Talus--\> Head--\> Inferior surface articulates with plantar calcaneonavicular (spring) ligament [p] • Fibrocartilage – Superior portion of spring ligament -\> where head of talus rests
41
Function of the Lumbrical Muscles
On contraction, they tighten the wing and loosen the sling allowing the more proximal parts of the extensor expansion to permit flexion at the metatarsophalangeal joint while holding more distal joints in extension. It should be noted that the flexor digitorum longus muscle, because of its relationship with the lumbricals, DOES contribute to the function of the extensor hood.
42
Branches from the proximal part of the lateral tarsal artery provide
vascular supply to the head and neck of the talus. Smaller branches supply the other tarsal bones and intertarsal joints
43
cuboid --\> anterior surface
o Vertical ridge – separates two facets Medial facet • Quadrilateral, articulates with base of fourth metatarsal Lateral facet • Triangular with apex laterally directed--\> articulates with fifth metatarsal
44
Extensor Expansion of the Hallux wing and sling--\> on the lateral side they are formed by
the adductor hallucis and flexor hallucis brevis.
45
Inferior Extensor Retinaculum -The laterally directed stem of the "Y" is named what and attaches where
The laterally directed stem of the "Y" (frondiform portion), forming the lateral root of the ligament, is attached to the dorsal and anterior aspect of the calcaneus just anterior to the sulcus calcanei.
46
The first dorsal metatarsal artery provides vascular supply to
the first dorsal interosseous muscle, articular branches to the first metatarsophalangeal joint and the soft tissues around the medial side of the first toe and the adjacent sides of the first and second toes.
47
- Miscellaneous sesamoid bones within tendons (order of decreasing frequency):
* - 1) flexor digitorum brevis to the second toe – at MPJ joint
* 2) flexor digitorum brevis to the fifth toe – at MPJ joint
* - 3) tibialis posterior – beneath navicular
* - 4) flexor digitorum brevis to the third toe – at MPJ joint
* - 5) flexor digitorum brevis to the fourth toe – at MPJ joint
* - 6) flexor hallucis longus – at IPJ (interphalangeal joint)
* - 7) flexor digitorum longus – at proximal interphalangeal joints:
* frequency in order, toe: 2, 5, 3, 4 (Note: same order as flexor digitorums) Note: “brevis, brevis, Tom, brevis, brevis, Hal, Dick”
* - 8) tendons as they cross malleoli
* a) Tibialis posterior
* b) Flexor digitorum longus
* c) Flexor hallucis longus
* d) Peroneus longus
* e) Peroneus brevis Note: “the order virtually goes in order from medial to lateral across the posterior muscle group with exception of the peroneuses being opposite in order. Variation on pneumonic: Tom, Dick, and Hal cross the mall to fetch a Peroneus Lost Bone”
48
Great Toe -- Distal Phalanx - Base -• Plantar surface
o Attachment of flexor hallucis longus (obliquely directed ridge/tuberosity which courses along the entire plantar surface)
49
The dorsalis pedis, in a majority of cases (\_\_\_\_%), can be traced distally across
* 75%
* the talus, navicular, intermediate cuneiform and the base of the second metatarsal bone to the first intermetatarsal space
50
Fifth Metatarsal - Base - Plantar surface -4 Attachments:
* 1) Flexor digiti quinti brevis (partial origin) {W}
* 2) plantar ligament of the sole (calcaneometatarsal ligament) {X} o Thickening of plantar aponeurosis
* 3) plantar cuboideometatarsal ligament {S}
* 4) plantar intermetatarsal ligament {P} Note: abductor os metatarsi digit minimi (accessory muscle) – at times inserts into plantar surface of base {Y}
51
Fourth Metatarsal - Base - Medial Surface
Oval facet – divided by a ridge • Anterior part – articulates with 3rd metatarsal • Posterior part – articulates with lateral cuneiform
52
largest cuneiform
medial cuneiform
53
54
Second Metatarsal - Base
o Wedged shaped / pyramidal – apex directed plantarly o Borders: dorsal, lateral, and medial
55
Third Metatarsal -Head -Plantar surface
Groove for flexor tendons
56
The extensor digitorum longus tendon of digits two, three, four and five - For the fifth digit what contributes to the lateral aspect of the expansion?
For the fifth digit, tendons of the abductor digiti minimi and flexor digiti minimi contribute to the lateral aspect of the expansion.
57
Navicular Plantar surface
o Continuous medially with navicular tuberosity
58
There is a great deal of variation in the location and size of the dorsalis pedis artery. It may be very large or so small that it is virtually absent. In cases where the artery is deficient or absent,
, the plantar arteries or the perforating branch of the peroneal artery take over. In case the anterior tibial artery is absent (5%), the dorsalis pedis then usually originates from the perforating branch of the peroneal artery.
59
Dorsal Metatarsal Arteries 2 to 4 The arteries are numbered 2 to 4 from the medial to lateral side. At the proximal end of the interosseous spaces they receive
receive the posterior perforating branches of the plantar arch. At the distal end of the interosseous space, the dorsal metatarsal arteries receive the anterior perforating branches from the plantar metatarsal arteries.
60
Third Metatarsal -base -articular areas -Medial Surface
• Two demarcates (1 dorsal, 1 plantar)- articulates with 2nd metatarsal • Attachment: interosseous intermetatarsal ligament {J}
61
Navicular - Anterior Surface o Large articular facet
– divided into 3 articular surfaces (for cuneiforms) by 2 vertical crests/ridges All articulate with appropriate cuneiform bones • Medial facet – largest. It is either pear, triangular or quadrilateral shaped • Middle (intermediate) facet – triangular • Lateral facet – triangular
62
Dorsalis Pedis Branches
* 1. Lateral tarsal
* 2. Medial tarsal
* 3. Arcuate
* 4. 1st dorsal metatarsal artery
* 5. Deep plantar There are many other unnamed muscular and nutrient twigs that arise from the dorsalis pedis as it works its way towards the 1st interosseous space. Other small branches arising from the dorsalis pedis, along with branches of the lateral tarsal and arcuate arteries, form an anastomotic network (rete) along the dorsum of the foot
63
Fifth Metatarsal - Base - Medial surface
Triangular or oval facet (articulates with 4th metatarsal) -1 Attachment: • 1) interosseous intermetatarsal ligament {J}
64
Arcuate Artery In about \_\_\_\_% of cases, this artery originates from the ______ at the level of the\_\_\_\_\_\_\_
In about 65% of cases, this artery originates from the dorsalis pedis artery at the level of the first tarsometatarsal joint. In other cases, its origin can be slightly more proximal and, therefore, it can be confused with the distal lateral tarsal artery
65
Intermediate Cuneiform -- Anterior Surface
-Triangular facet – articulates with 2nd metatarsal
66
Medial Cuneiform -Plantar Surface - Ligament attachments
Ligament Attachments: • 1) plantar cuneonavicular • 2) plantar intercuneiform • 3) plantar cuneometatarsal (to first metatarsal) • 4) plantar cuneometatarsal (to second metatarsal)
67
Extensor Expansions -Long and short extensor tendons are held in place by two fibrous sheaths. These sheaths are continuous with ____ and form \_\_\_\_
each other and form a strong fibrous structure called the extensor hoods.
68
At the ankle joint, the anterior tibial artery continues onto the dorsum of the foot as
the dorsalis pedis artery The name change happens at an imaginary line joining the medial and lateral malleoli (transmalleolar line).
69
First Metatarsal
- Thickest, heaviest, strongest, short shaft (shortest of the 5)
70
Talus- posterior process -lateral tubercle has what attachments?
1. Posterior talofibular 2. Posterior talocalcaneal 3. Fibulotalocalcaneal
71
Inferior Extensor Retinaculum -The superolateral oblique band extends
extends from the superomedial oblique band and frondiform ligament laterally to attach on the lateral surface of the lateral malleolus. -It merges with the superior extensor retinaculum and the superior peroneal retinaculum.
72
Extensor Expansion of the Hallux
On the first digit, only the tendon of the extensor hallucis longus is attached to the extensor expansion. The plantar plate is attached to the deep transverse ligament on the lateral side only. A wing and sling are present, but lumbricals and interossei do not contribute to them. On the medial side they are formed by the abductor hallucis, while on the lateral side, they are formed by the adductor hallucis and flexor hallucis brevis.
73
prevent bow stringing of the tendons of the extrinsic muscles of the foot.
retinacula
74
Calcaneus -Lateral Surface o Peroneal trochlea
-present 33% of time -Ridge of bone – formed by groove for peroneus longus tendon lies inferior & posterior to the Peroneal trochlea
75
Medial Cuneiform -Plantar Surface -muscle insertions
Partial muscle insertions: • 1) Tibialis anterior • 2) Tibialis posterior • 3) Peroneus longus
76
Extensor Expansions -what contributes to the formation of the sling but not of the wing?
. Interosseous muscles
77
Nerves of Dorsum of Foot Saphenous Nerve
The saphenous nerve, a sensory branch of the femoral nerve, follows the great saphenous vein in the leg along its lateral side and enters the dorsum of the foot anterior to the medial malleolus. It courses along the medial border of the foot as far as the first metatarsal bone. It innervates the skin along the medial side of the foot as far as the bse of the 1st metatarsal bone.
78
From its origin, the arcuate artery runs
runs laterally across the bases of the second, third and fourth metatarsal bones. The tendons of the extensor digitorum brevis cross its superficial surface. On the lateral side of the foot, it anastomoses with the lateral tarsal and lateral plantar arteries. While the arcuate artery is crossing the foot from the medial to the lateral side, it gives rise to the 2nd, 3rd and 4th dorsal metatarsal arteries.
79
Calcaneus -Lateral Surface
o Broader posterior vs. anterior o Most variable surface (1, 2, or 3 tubercles)
80
Talus- posterior process -lateral tubercle
o larger than medial
81
Extensor Digitorum Brevis Nerve
The lateral terminal branch of the deep peroneal nerve is the most common innervation of this muscle. However, when an accessory peroneal branch of the superficial peroneal nerve is present (20% of cases) it usually aids in innervating the muscle.
82
Fourth Metatarsal - Base - Lateral Surface
Large Triangular or Oval, large facet – articulates with 5th metatarsal 1 Attachment • 1) interosseous intermetatarsal ligament {J}
83
most typical cuneiform (most similar to wedge shaped)
intermediate cuneiform
84
The extensor digitorum longus tendon of digits two, three, four and five -The two lateral slips converge over the distal end of the middle phalanx. These rejoined tendinous slips pass
These rejoined tendinous slips pass distally as the terminal slip to insert on the base of the distal phalanx
85
Fourth Metatarsal - Base - Plantar surface
Attachments:
* (Origin) Adductor hallucis (oblique head) {O} Note: plantar bases 2nd and 3rd metatarsal, other locations for origin
* Tibialis posterior {N}
* Long plantar ligament {M}
* Plantar cuboideometatarsal ligament {S}
* 1) plantar intermetatarsal ligament (to 3rd metatarsal) {P}
* 2) plantar intermetatarsal ligament (to 5th metatarsal) {P}
86
Calcaneus -Medial Surface
o Deeply concave – plantar nerves & vessels lie within the cave
o “M” Medial head of quadratus plantae attaches to medial surface (more extensive attachment than to medial process (plantar surface))
87
-Lisfranc's ligament
-medial Cuneiform -Lateral surface -(interosseous tarsometatarsal ligament) o Attached to the lateral surface of medial cuneiform + second metatarsal
88
Medial Cuneiform -Lateral Surface -Ligament Attachments
2 ligament attachments • Lisfranc’s ligament (interosseous tarsometatarsal ligament) o Attached to the lateral surface of medial cuneiform + second metatarsal • Interosseous intercuneiform ligament (to intermediate cuneiform)
89
Lesser Toes o Bases:
Oval facets (articulate with metatarsal heads)
90
Fifth Metatarsal - Base - Posterior surface
Triangular facet (articulates with cuboid)
91
The deep fascia divides the dorsum of the foot into _____ layers arranged from superficial to deep
three
92
Third Metatarsal -base o Dorsal Surface
3 ligament attachments • 1) dorsal intermetatarsal ligament (to 2th metatarsal) {L} • 2) dorsal intermetatarsal ligament (to 4th metatarsal) {L} • Dorsal cuneometatarsal ligament (to lateral cuneiform) {C}
93
smallest of seven tarsal bones
intermediate cuneiform
94
Second layer of the deep fascia (dorsum of the feet) contains
the extensor digitorum brevis muscle
95
First Dorsal Metatarsal Artery The medial branch
courses medially over the head of the first metatarsal bone and deep to the tendons of extensor hallucis longus and brevis to vascularize the medial side of the great toe as the first dorsal digital artery
96
o Tuberosity for tibialis posterior
Navicular--\> Medial surface -Sometimes the tuberosity develops froms a secondary ossification center that does not unite with the rest of the Navicular. Results in an accessory bone the os tibiale (externum)
97
Talus- posterior process -lateral tubercle has it's own
secondary ossification center
98
Superficial Veins of the Foot . The medial marginal vein is formed by
by the union of the medial dorsal digital vein of the first toe and the medial end of the dorsal venous arch.
99
Cuneiform Bones -Apices
Medial cuneiform – dorsally directed Intermediate & lateral – plantarly directed
100
Talus -Medial surface--\>inferior to articular facet
-Rough surface for the attachment of Anterior tibiotalar ligament (part of deltoid ligament) -• Many vascular foamina inferior to the comma shaped facet (articular facet)
101
Superfiical Peroneal Nerve The medial dorsal cutaneous nerve of the foot
communicates with the saphenous nerve and on occasion, with the medial terminal branch of the deep peroneal. It gives rise to one dorsal digital branch (1st dorsal digital nerve) and one common dorsal digital branch (1st common dorsal digital nerve). The 1st dorsal digital nerve innervates the medial side of the great toe. The 1st common dorsal digital branch courses to the space between toes two and three, where it divides into the 4th and 5th dorsal digital nerves
102
Intermediate Cuneiform -Lateral surface
o Articular facet – smooth, elongated oval shaped (vertical direction) o Non-articulated area – attachment of interosseous intercuneiform ligament (with lateral cuneiform)
103
Lateral Cuneiform - Plantar Surface - muscle attachments
1) flexor hallucis brevis 2) tibialis posterior
104
Fourth Metatarsal - Shaft
o Triangular in shape (cross section) o 3 Surfaces: dorsal, lateral, medial Note: same general shape as shafts of 2nd and 4th metatarsals
105
cuboid --\> anterior surface--\> lateral facet
o Vertical ridge – separates two facets (this is one, medial is other) • Triangular with apex laterally directed--\>articulates with fifth metatarsal
106
Cuboid- Lateral surface -on plantar edge
Peroneal notch
107
Dorsal Metatarsal Arteries 2 to 4 In the absence of the arcuate artery
, the posterior perforating arteries are usually larger and give rise to the 2nd, 3rd and 4th dorsal metatarsal arteries.
108
Ossification of Foot Bones - Metatarsals
o Each has 2 centers: Diaphysis (shaft) – appears during fetal life Epiphysis • 1st metatarsal (base) – appears during year 3 • 2-5th metatarsals (head) – appears during years 5-8
109
Cuboid - Bone direction/orientation:
-Superior surface – superolateral -inferior surface – inferomedial
110
Lesser Toes - Plantar surface
2 plantar tubercles (1 medial, 1 lateral) • Toe 2: Both for dorsal interossei • Medial Plantar tubercle o Toes 3-5: for plantar interossei • Lateral Plantar tubercle o Toes 3, 4: for dorsi interossei o Toe 5: abductor digiti quinti + flexor digit quinti (brevis)
111
Second Metatarsal -base -Medial surface
Oval, small facet – articulates with medial cuneiform Note: Occasionally, second oval, small facet is located anterior & inferior to the facet for the medial cuneiform (variable occurance). It is a pressure facet for first metatarsal – formed by contact between the bones
112
In some cases (\_\_\_\_\_% ) the artery to the sinus tarsi originates from the lateral tarsal artery.
20-30%
113
Metatarsal Bones
- 5 metatarsal bones (miniature long bones)
114
Intermediate Cuneiform -Plantar Surface
o Is the apex of the wedge
o Rather thin surface and therefore a crest
o Attachments:
1) plantar cuneonavicular ligament
2) plantar intercuneiform ligament (to medial cuneiform)
3) plantar intercuneiform ligament (to lateral cuneiform)
Tibialis posterior (partial attachment) Note: there is no ligament attachment from this cuneiform to a metatarsal plantarly (picked up by medial & lateral cuneiform ligaments)
115
Cuboid -Coronoid process “beak”
-Inferior Surface (plantar surface) -located at point where medial and posterior borders meet
116
A dorsalis pedis pulse can be taken while the artery is passing
anterior to the tarsal bones, between the tendons of extensor hallucis longus medially and extensor digitorum longus laterally. Often, if the pulse cannot be detected, it is because the anterior tibial artery after giving off its malleolar branches terminates as a small twig at the ankle joint. In this case the perforating branch of the peroneal artery, which lies more laterally, vascularizes the area of the dorsum of the foot normally supplied by the dorsalis pedis
117
Superior Extensor Retinaculum blends with
. It blends with the superior peroneal retinaculum LATERALLY, and with the proximal border of the inferior extensor retinaculum and the flexor retinaculum MEDIALLY.
118
Lateral Cuneiform - Plantar Surface -ligament attachments
1) plantar cuneocuboid 2) plantar cuneonavicular 3) plantar intercuneiform 4) plantar cuneometatarsal Note: one to each bone that surrounds this cuneiform.
119
Cuboid Peroneus longus tendon lies
-in peroneal groove or against anterior part of peroneal ridge
120
Retrotrochlear eminence origin
-Calcaneus -Lateral Surface -bony trabeculae within calcaneus that fan out from articular surfaces
121
Deep Veins of the Foot The anterior tibial vein (s) originates from
the venous plexus along the dorsum of the foot.
122
Calcaneus -Lateral Surface most constant feature
o Retrotrochlear eminence
123
Cuboid Peroneal sulcus lies
distal to peroneal ridge
124
part of deltoid ligament
Anterior tibiotalar ligament
125
Medial Cuneiform -Posterior surface -shape
Concave
126
Where is a large Ovoid, convex facet – articulates with navicular
Anterior surface of the Head of the Talus
127
Talus -Head -Inferior surface
-3 facets 2 facets – articulate with calcaneus • Anterior calcaneal facet(on talus) – articulates with anterior talar facet (on superior surface calcaneus) • Middle calcaneal facet (on talus) – articulates with middle talar facet (on superior surface calcaneus) 1 facet that rests on the spring ligament– articulates with plantar calcaneonavicular (spring) ligament [p] • Fibrocartilage – Superior portion of spring ligament -\> where head of talus rests
128
First layer of the deep fascia (dorsum of the feet) contains
the tendons and accompanying synovial sheaths of the tibialis anterior, extensor hallucis longus, extensor digitorum longus and peroneus tertius muscles.
129
Cuboid
- Lateral bone – distal row tarsals
130
Talus o Posterior surface aka
posterior process
131
Talus -Articular Facet
-Medial surface -(Comma-shaped facet – located superiorly) – articulates with medial malleolus “comma in the medial of a sentence”
132
o 2 tendon attachments – inferiorly near plantar surface: 1) Tibialis anterior (medial surface) 2) Peroneus longus (lateral surface)
First Metatarsal -base--\>tendon attachments
133
Intermediate Cuneiform - Ligaments attached to the dorsal surface
1) dorsal cuneonavicular 2) dorsal intercuneiform (to medial cuneiform) 3) dorsal intercuneiform (to lateral cuneiform) 4) dorsal cuneometatarsal Note: there is a ligament to each of four bones bordering this cuneiform dorsally
134
o Smallest surface of cuboid (more of a border)
-Lateral surface
135
- 8) tendons as they cross malleoli
a) Tibialis posterior b) Flexor digitorum longus c) Flexor hallucis longus d) Peroneus longus e) Peroneus brevis Note: “the order virtually goes in order from medial to lateral across the posterior muscle group with exception of the peroneuses being opposite in order. Variation on pneumonic: Tom, Dick, and Hal cross the mall to fetch a Peroneus Lost Bone”
136
structures attached to plantar surface of the cuboid
o 8 ligament attachments: 1) Long plantar [24] 2) Short plantar [25] 3) Tibialis posterior [27] 4) Flexor hallucis brevis [29] 5) Plantar cuneocuboid 6) Plantar cuboideonavicular 7) plantar cuboideometatarsal to fourth metatarsal 8) plantar cuboideometatarsal to fifth metatarsal
137
Navicular --\> Lateral surface
o Narrow, edge like
138
Medial Cuneiform -Medial Surface
Quadrilateral shape Often palpable subcutaneously NO bone-bone articulations on this surface – still has a small anterior-inferior facet
139
Metatarsal Bones - proximal
o Proximal extremity (base) – articulate with distal row of tarsal bones
140
Retinacula of the Ankle Superior Extensor Retinaculum - Attaches (laterally)
The superior extensor retinaculum (ligamentum transversum cruris; superior part of the anterior annular ligament) attaches laterally to the distal end of the fibula on its anterior border, and on the lateral surface of the lateral malleolus
141
Third Metatarsal -base -articular areas -Posterior Surface
• Triangular facet (articulates with lateral cuneiform)
142
Third Metatarsal -Head
- Trochlear, convex shape -Articulates with base of proximal phalanx Note: Head is similar to those of other metatarsals.
143
Fourth Metatarsal - Head -Plantar surface
Groove for flexor tendons
144
Fifth Metatarsal - Base - Plantar surface - Groove
abductor digiti quinti (groove made by this tendon
145
The only intrinsic muscle of the dorsum of the foot
the extensor digitorum brevis.
146
Medial Cuneiform -Anterior Surface
Kidney shaped (reniform) surface Articulates with base of first metatarsal
147
Cuneiform Bones
o Cuneiform in latin means “wedge” shaped o 3 bones: medial, intermediate, lateral
148
only the tendon of the extensor hallucis longus is attached to \_\_\_\_
the extensor expansion.
149
Extensor Expansion of the Hallux ____ and ___ are present
A wing and sling are present, but lumbricals and interossei do not contribute to them
150
Great Toe - Shaft -Dorsally
Dorsally – Convex
151
Navicular articulations
talus, three cuneiforms, it may articulate with the cuboid, rarely calcaneus
152
Second Metatarsal - Shaft -Attachments
1) lateral head of first dorsal interosseous (on medial surface) 2) medial head of second dorsal interosseous (on lateral surface)
153
Lesser Metatarsal Bones
4 lesser (digits 2-5) Bases (proximal extremity) articulate with each other thin, long shafts
154
Second Metatarsal -base -Ligament attachments to lateral surface:
• 1) interosseous intermetatarsal {J} • 2) interosseous cuneometatarsal {K}
155
The common dorsal digital arteries are very short and, at the webbing of the toes, each artery divides into
two dorsal digital arteries to supply the adjacent sides of toes 2 to 5. These arteries are numbered 4 to 9. The dorsal digital arteries of each toe communicate with each other at the distal end of the toes. Either directly from the lateral part of the arcuate artery or from the 4th dorsal metatarsal artery, a branch is given off to the lateral aspect of the fifth toe and is known as the 10th dorsal digital artery. The dorsal digital arteries 1 to 3 are branches of the first dorsal metatarsal artery
156
Calcaneus -Medial Surface o Sustantaculum tali
-“sustains talus” – holds it up -Shelf like on medial surface -Superior surface articulates with talus -Inferior surface groove by tendon of flexor hallucis longus
157
Lesser Toes
o Proximal phalanges length \> middle + distal phalange length
158
Talus - Neck in an articulated foot what together forms a bony canal called the tarsal canal and tarsal sinus?
the grooves of the sulcus tali & calcaneal sulcus
159
Third Metatarsal -Shaft -3 muscle attachments:
1) Lateral head of second dorsal interosseous 2) Medial head of third dorsal interosseous 3) First plantar interosseous
160
Cuboid -Medial surface has
-a Triangular facet for lateral cuneiform at the dorsal, middle portion--\> usually this is the only facet -Occasionally small facet for navicular bone
161
Inferior Extensor Retinaculum -The superomedial oblique band -The superficial layer passes
The superficial layer passes superficial to the tendon of the extensor hallucis longus, the anterior tibial artery and vein and deep fibular nerve.
162
Talus--\> Head--\> Inferior surface 2 facets – articulate with calcaneus
• Anterior calcaneal facet [9] (on talus) – articulates with anterior talar facet (on superior surface calcaneus) • Middle calcaneal facet [11] (on talus) – articulates with middle talar facet (on superior surface calcaneus)
163
Cuboid - Superior Surface (dorsal surface)
o Rough surface for 6 ligament attachments: 1) dorsal calcaneocuboid 2) dorsal cuneocuboid 3) dorsal cuboideonavicular 4) dorsal cuboideometatarsal to fourth metatarsal 5) dorsal cuboideometatarsal to fifth metatarsal 6) lateral calcaneocuboid (variable) (NOTE: one to each of the surrounding 5 bones – origin named first then insertion, 5 consistent attachments named dorsal first for dorsal surface)
164
Lateral Cuneiform - Plantar Surface
o Apex of wedge o 2 muscle attachments 1) flexor hallucis brevis 2) tibialis posterior o 4 ligament attachments 1) plantar cuneocuboid 2) plantar cuneonavicular 3) plantar intercuneiform 4) plantar cuneometatarsal Note: one to each bone that surrounds this cuneiform.
165
Intermediate Cuneiform -Shape
Quadrilateral or square
166
Great Toe - Proximal Phalanx - Base Plantar surface
Plantar surface (near the base) • Two tubercles: medial & lateral plantar tubercles o Medial Plantar tubercle – Larger than lateral 2 attachments: • Medial head of flexor hallucis brevis • Abductor hallucis o Lateral Plantar tubercle – 2 attachments: • lateral head of flexor hallucis brevis • Adductor hallucis
167
Attachment of calcaneofibular ligament
Calcaneus -Lateral Surface o Third tubercle of peroneal trochlea
168
os tibiale (externum)
An accessory bone. Sometimes the tuberosity of the medial surface of the navicular develops froms a secondary ossification center that does not unite with the rest of the Navicular.
169
The extensor digitorum longus tendon of digits two, three, four and five -The two lateral slips converge
converge over the distal end of the middle phalanx.
170
The deep plantar artery is one of the two terminal branches of
the dorsalis pedis.
171
Extensor Expansions - The distal part of the extensor hood is called ____ and formed from \_\_\_\_\_
The distal part of the extensor hood, called the extensor wing, is formed mostly from expansions of the tendons of the lumbrical muscles
172
Intermediate Cuneiform -Attachments
1) plantar cuneonavicular ligament 2) plantar intercuneiform ligament (to medial cuneiform) 3) plantar intercuneiform ligament (to lateral cuneiform) Tibialis posterior (partial attachment) Note: there is no ligament attachment from this cuneiform to a metatarsal plantarly (picked up by medial & lateral cuneiform ligaments)
173
cuboid --\> anterior surface--\> medial facet
o Vertical ridge – separates two facets (this is one, lateral is other) • Quadrilateral, articulates with base of fourth metatarsal
174
Deep Peroneal Nerve
The deep peroneal nerve passes from its origin deep to the peroneus longus to the anterior surface of the interosseous membrane. It accompanies the anterior tibial artery from the proximal one-third of the leg and passes with it deep to the extensor retinaculum. Immediately distal to the extensor retinaculum, it divides into medial and lateral terminal branches. Muscular branches of the deep peroneal nerve serve the tibialis anterior, extensor digitorum longus, peroneus tertius and extensor hallucis longus. The deep peroneal nerve also provides an articular branch to the ankle joint.
175
Great Toe - Shaft -Plantarly
Plantarly – Concave • Concave • Slightly grooved (caused by tendon of flexor hallucis longus)
176
First Metatarsal -head location
o Distal location
177
Sustantaculum tali 4 attachments
• “M” Medial talocalcaneal ligament • “R” Recurrent band of tibialis posterior (partial insertion) • “T” Tibiocalcaneal ligament (part of deltoid ligament) • “P” Plantar calcaneonavicular (spring) ligament “MR T.P.” – Sustantaculum Tali looks sort of like a Tepee
178
Third Metatarsal - Shaft
o Triangular in shape (cross section)
179
Medial Tarsal Arteries
(2) These arteries are small and variable. There are usually two in number and originate from the dorsalis pedis opposite the origin of the proximal lateral tarsal artery. They supply the medial aspect of the tarsal bones and terminate by contributing to the medial malleolar rete
180
Deep Veins of the Foot The proper plantar digital veins communicate with
with the dorsal digital veins and then unite to form four plantar metatarsal veins.
181
Superficial Veins of the Foot The arch, on its lateral side, is joined by
the lateral dorsal digital vein of the fifth toe to form the lateral marginal vein
182
Extensor Digitorum Brevis Function
The extensor digitorum brevis acts as an aid to the extensor digitorum longus in extension of the phalanges of the second, third and fourth digits. If contraction continues, it also extends the metatarsophalangeal (MP) joints. When the long and short extensors act without the lumbricals, they extend the MP joints by tightening the extensor sling and pulling the plantar pad against the proximal phalanx.
183
The extensor digitorum longus tendon of digits two, three, four and five -The two lateral slips run
along each side of the proximal and middle phalanges
184
Muscles of the Dorsal Surface Extensor Digitorum Brevis from its origin it passes:
From its origin it passes diagonally across the foot from lateral to medial, to end in four fleshy tendons. The most medial of these tendons crosses the dorsalis pedis artery and it is sometimes described as a separate muscle, the extensor hallucis brevis.
185
Ossification of Foot Bones - Accessory bones
o Each forms as separate secondary ossification center
186
At the ankle, the deep fascia forms several specialized thickenings called ____ that \_\_\_\_\_\_
At the ankle, the deep fascia forms several specialized thickenings called the retinacula, which prevent bow stringing of the tendons of the extrinsic muscles of the foot.
187
Cuboid o superficial fibers of long plantar ligament course
over tendon of peroneus longus
188
Phalanages
- Great toe – 2 phalanges (proximal & distal) - Lesser toes (2-5) – 3 phalanges (proximal, middle, & distal)
189
First Metatarsal -base--\>tendon attachments
o 2 tendon attachments – inferiorly near plantar surface: 1) Tibialis anterior (medial surface) 2) Peroneus longus (lateral surface)
190
First Metatarsal o Articular posterior surface
-on base – concave, reniform (kidney-shaped) facet Note: matches medial cuneiform
191
The extensor digitorum brevis muscle takes partial origin
from the deep surface of the frondiform ligament.
192
Great Toe -- Distal Phalanx - Base -Dorsal Surface
o Attachment of Extensor hallucis longus (tuberosity near the base)
193
Third Metatarsal - Shaft -Surfaces
o 3 Surfaces: dorsal, lateral, medial Note: same general shape as shafts of 2nd and 4th metatarsals
194
Lateral Cuneiform -Dorsal surface
o Rectangular in shape o Rough for ligament attachments: 1) dorsal cuneocuboid 2) dorsal cuneonavicular 3) dorsal intercuneiform 4) dorsal cuneometatarsal (to second metatarsal) 5) dorsal cuneometatarsal (to third metatarsal)
195
Dorsalis Pedis The first part of the artery
is very superficial, being covered by skin, fascia and the inferior extensor retinaculum
196
Talus -Lateral surface--\> Lateral process--\> 2 attachments
-Rough areas anterior and posterior to triangle facet -Anterior talofibular ligament • Two tubercles for attachment -Posterior talobifular ligament • Groove for attachment
197
calcaneofibular ligament
• Constant ligament; tuberosity on calcaneus is variable • Lateral talocalcaneal ligament attaches anterior & superiorly to the calcaneofibular ligament ; partially overlaiden by calcaneofibular ligament
198
Second Metatarsal
- Longest of -metatarsals, extends more proximally than others -- Articulates proximally with all three cuneiforms
199
Extensor Digitorum Brevis Variations
There may be accessory slips of origin from the talus and navicular, or lateral cuneiform and third metatarsal, or cuboid. There may be only two tendons, or the tendons may be doubled. Finally, an accessory tendon to the fifth digit may be present.
200
Medial Cuneiform Base location
located at plantar surface
201
Calcaneus -Lateral Surface -Second groove of peroneal trochlea
-rarely present -Superior & somewhat anterior to peroneal trochlea -Formed by tendon of peroneus brevis
202
Navicular --\> Dorsal surface
o Convex, orientated superomedially
o Rough surface due to 5 ligament attachments:
1) dorsal cuneonavicular to medial cuneiform
2) dorsal cuneonavicular to intermediate cuneiform
3) dorsal cuneonavicular to lateral cuneiform
4) dorsal cuboideonavicular
5) dorsal talonavicular
6) calcaneonavicular portion of bifurcate ligament [29]
7) tibionavicular portion of deltoid ligament Note: ligaments to ALL surrounding bones, even tibia, all named dorsal with exception the two bones farthest away, which are portions of ligaments”
203
Deep Veins of the Foot The deep plantar venous arch follows
the deep plantar arterial arch across the interossei muscles. The medial and lateral plantar veins originate from the arch and run along with the arteries of the same name. There usually are some communicating veins between the medial and lateral plantar veins and the small and great saphenous veins.
204
Extensor Expansion of the Hallux wing and sling--\>on the medial side they are formed by
the abductor hallucis
205
Talus -Lateral surface--\>Lateral talocalcaneal ligament
• Attaches anteroinferior to lateral malleoolar surface
206
Lateral Cuneiform - posterior surface
o Triangular surface – articulates with navicular
207
The bones of the lateral arch are?
-Metatarsals 4 and 5 -Cuboid -Calcaneus -Talus
208
distinctive feature of Third Metatarsal
Groove [10a] – inferior to oval facet where there is an attachment: interosseous intermetatarsal ligament
209
Posterior articular facet
- inferior surface of Talus -large oval, concave surface that articulates with calcaneus at subtalar joint
210
What part of the Intermediate Cuneiform is rather thin and therefore a crest?
Plantar surface
211
Medial Cuneiform -Lateral Surface -Facets
• Small oval shaped, anteriorly – for base of second metatarsal • Inverted “L” shaped , horizontal part superior, vertical part posterior – for intermediate cuneiform
212
• Interosseous intercuneiform ligament
-medial Cuneiform -Lateral surface - To intermediate Cuneiform
213
First Dorsal Metatarsal Artery
The dorsalis pedis artery after giving off the arcuate artery continues into the first interosseous space where it provides its terminal branches, the deep plantar and the first dorsal metatarsal arteries. The first dorsal metatarsal artery continues distally in the first interosseous space over the dorsum of the first dorsal interosseous muscle and divides into a medial and a lateral branch.
214
Great Toe - Head
Vertically – Flat Trochlear (“sideways saddle”) articulating surface – large and extends more plantarly than dorsally
215
Calcaneus -Lateral Surface o Retrotrochlear eminence
Lies directly posterior the peroneal trochlea (tuberosity) Located in middle third of lateral surface
216
Second Metatarsal -base -posterior surface
-Triangular facet – articulates with intermediate cuneiform
217
os trigonum
When ossification center fails to fuse with the rest of talus =\> lateral tubercle is anaccessory bone (called os trigonum) -Talus- posterior process -lateral tubercle
218
Talus
- Articulates with tibia and fibula (ankle joint) - Three portions: body, neck, head - NO MUSCLE or TENDON attachments
219
Great Toe - Proximal Phalanx - Base Dorsal surface
Dorsal surface (close to the base) • Transverse crest (tubercle) – close to the base o Insertion of Extensor hallucis brevis
220
Talus -Body--\>Inferior surface
-Posterior articular facet -Sulcus tali
221
o 2 ligament attachments 1) dorsal cuneometatarsal (medial surface) 2) plantar cuneometatarsal (inferior surface)
First Metatarsal -base--\>ligament attachments
222
Talus -Lateral surface
Triangle shape Apex pointing inferiorly
223
Metatarsal Bones -distal extremity
o Distal extremity (head) Convex Plantar surface extends proximally further than the dorsal surface Attachment: deep transverse metatarsal ligament (attaches heads of all five metatarsals)
224
Dorsal Metatarsal Arteries 2 to 4 Normally, these arteries are branches of
the arcuate artery. They pass distally from the arcuate artery along the superficial surface of each dorsal interosseous muscle in each interosseous space.
225
Peroneal trochlea
Calcaneus -Lateral Surface
226
Navicular--\> Medial surface
o Tuberosity for tibialis posterior (tuberosity variable in size) o Attachment of Medial cuneonavicular ligament (attaches to medial cuneiform)
227
Talus Shape
o The body is somewhat cuboidal o Anterior surface blends with neck - Other five surfaces are free
228
Fifth Metatarsal - Shaft -Attachments (origins):
o 2 Muscle Attachments (origins): 1) Lateral head of 4th dorsal interosseous 2) 3rd plantar interosseous
229
Sesamoid Bones
- Form (developmentally) within tendons; usually small bones - More seasmoid bones in foot than rest of body
230
Lateral Cuneiform - Lateral Surface -Shape
o Rectangular in shape
231
Talus - Neck -Superior surface attachment
(dorsal) talonavicular ligament
232
Talus- posterior process is grooved by
the tendon of the Flexor hallucis longus which divides posterior process into 2 tubercles: medal and lateral tubercles
233
Extensor Expansions -Long and short extensor tendons are held in place by
two fibrous sheaths
234
Intermediate Cuneiform -Dorsal Surface
o Quadrilateral or Square o Forms base of the cuneiform o Rough for ligament attachment: 1) dorsal cuneonavicular 2) dorsal intercuneiform (to medial cuneiform) 3) dorsal intercuneiform (to lateral cuneiform) 4) dorsal cuneometatarsal Note: there is a ligament to each of four bones bordering this cuneiform dorsally
235
Deep Plantar Artery arises from
the dorsalis pedis at the proximal part of the first interosseous space
236
Inferior Extensor Retinaculum -The superomedial oblique band -The superficial layer --\>After passing the extensor hallucis longus tendon, it fuses with
the deep layer and, with the deep layer, forms a tunnel for the tendon of the tibialis anterior
237
Extensor Expansions -Long and short extensor tendons are held in place by two fibrous sheaths. These sheaths are continuous with each other and form a strong fibrous structure called the extensor hoods. The more proximal part is called\_\_\_\_\_ and is formed from ____ and attached to \_\_\_\_
. The more proximal part, called the extensor sling, is formed from fibers which encircle the digit to attach to a thickening in the plantar metatarsophalangeal ligament called the plantar plate. There is a plantar plate for each digit.
238
Inferior Extensor Retinaculum -The superomedial oblique band attaches
The superomedial oblique band attaches medially on the anterior surface of the medial malleolus.
239
Fifth Metatarsal - Shaft - Surfaces:
dorsal, medial, inferior Note: Orientation, different than 2nd – 4th metatarsals – inferior instead of lateral surface
240
Triangular facet on the Navicular
Middle (intermediate) facet and the lateral facet. -articulate with the intermediate and lateral cuneiform respectively
241
Third layer of the deep fascia (dorsum of the feet) contains
the dorsalis pedis artery and its branches, the deep peroneal nerve and its branches, the veins accompanying the dorsalis pedis artery and the termination of the perforating branch of the peroneal artery.
242
The lateral tarsal artery courses
courses laterally and distally across the calcaneonavicular junction and the dorsum of the cuboid. Here, it passes below the tendon of the peroneus brevis muscle to anastomose with the lateral plantar artery. While traveling laterally, it passes below the extensor digitorum brevis muscle which it supplies. It also provides branches which anastomose with the perforating branch of the peroneal artery, the arcuate artery and the anterior lateral malleolar rete.
243
Reniform surface on cuneiform
-Kidney Shaped - on anterior surface of medial cuneiform -articulates with base of the first metatarsal
244
Navicular --\> Lateral surface - attachments
lateral calcaneonavicular portion of bifurcate ligament (also attached to dorsal surface) interosseous cuboideonavicular ligament
245
Inferior Extensor Retinaculum -The inferomedial oblique band passes
superficially to the dorsalis pedis artery, deep peroneal nerve and tendons of the extensor hallucis longus and tibialis anterior muscles. Some fibers may pass deep to the tibialis anterior tendon forming a tunnel for it. The inferomedial oblique band passes medially to attach to the plantar fascia, navicular tuberosity and medial cuneiform.
246
Inferior Extensor Retinaculum -The superomedial oblique band
one of the arms of the "Y" of the frondiform ligament, has deep and superficial layers
247
Inferior Extensor Retinaculum -The intermediate root attaches
The intermediate root attaches to deeper portions of the sulcus calcanei.
248
Where is the transverse "arch" of the foot located and what forms it?
at the tarsometatarsal articulation. The four tarsal bones of the distal row and all five metatarsal bones form this arch.
249
Third Metatarsal -base o Plantar aspect (crest) Attachments:
• Adductor hallucis (Oblique head) {O} • Tibialis posterior {N} • Long plantar ligament {M} • Plantar cuneometatarsal ligament {D} • 1) plantar intermetatarsal ligament (to 2nd metatarsal) {P} • 2) plantar intermetatarsal ligament (to 4th metatarsal) {P}
250
Medial Cuneiform -Medial Surface -Ligament Attachments
o 1) medial cuneonavicular o 2) dorsal cuneonavicular o 3) dorsal intercuneiform o 4) dorsal cuneometatarsal (to first metatarsal) o 5) dorsal cuneometatarsal (to second metatarsal)
251
o Sulcus tali
deep groove, representing medial & inferior surfaces of the neck of the Talus
252
Deep Peroneal Nerve medial terminal branch
The medial terminal branch is found in company with the dorsalis pedis artery on the dorsum of the foot. In the first intermetatarsal space, it divides into two dorsal digital nerves which supply the skin of adjacent sides of the first and second digits. This dorsal digital nerve communicates with the medial dorsal cutaneous branch of the superficial peroneal nerve. An interosseous branch of the medial terminal branch supplies the metatarsophalangeal joint of the first digit and provides a sensory branch to the first dorsal interosseous muscle
253
First Metatarsal -Shaft -attachment
1) medial head of first dorsal interosseous muscle (lateral surface of shaft)
254
Peroneal ridge terminates laterally as
cuboid tuberosity
255
The deep fascia of the foot (called \_\_\_\_\_) is a continuation of _____ which is called \_\_\_\_\_
The deep fascia (dorsalis pedis fascia) is the continuation of the deep fascia (crural fascia) of the leg
256
Metatarsal Bones -shaft
o Body (shaft), convex dorsally, concave plantarly Longitudinal curve Thin and long (minus the 1st)
257
Arches of the foot
Bones of the foot are arranged into two longitudinal arches, medial and lateral
258
Talus- posterior process -Medial tubercle is located
o Medial to groove of flexor hallucis longus
259
The thin superficial fascia of the dorsum of the foot is a continuation of\_\_\_\_ and contains \_\_\_\_\_
the superficial fascia of the leg, contains superficial vessels and nerves
260
Inferior Extensor Retinaculum -The superolateral oblique band merges with
It merges with the superior extensor retinaculum and the superior peroneal retinaculum.
261
Cuboid -Medial surface attachments
o 3 ligament attachments: 1) interosseous cuboideonavicular 2) interosseous cuneocuboid 3) calcaneocuboid portion of bifurcate ligament
262
• Lateral talocalcaneal ligament attaches
anterior & superiorly to the calcaneofibular ligament ; partially overlaiden by calcaneofibular ligament
263
First Metatarsal o Transverse diameter of head
o Transverse diameter of head \> vertical diameter Note: other four metatarsals, vertical diameter \> transverse
264
talus -divides posterior process into 2 tubercles
tendon of the Flexor hallucis longus
265
1) medial head of first dorsal interosseous muscle (lateral surface )
First Metatarsal -Shaft -attachment
266
Fourth Metatarsal - Shaft - Attachments (origins):
1) lateral head of third dorsal interosseous 2) medial head of fourth dorsal interosseous 3) second plantar interosseous
267
First Dorsal Metatarsal Artery The lateral branch
continues distally and at the webbing of the toes divides into two branches to supply the adjoining sides of first and second toes as the second and third dorsal digital arteries, respectively.
268
First Metatarsal -Base
o Very broad, semi-triangular o Three surfaces: inferior, medial, lateral
269
Dorsal Metatarsal Arteries
There are four dorsal metatarsal arteries. The first dorsal metatarsal is a direct branch of the dorsalis pedis and the other three are branches of the arcuate artery. Each artery courses in its intermetatarsal space along the dorsal surface of the dorsal interosseous muscle and terminates at the metatarsophalangeal joint by dividing into two dorsal digital arteries
270
Nerves of Dorsum of Foot The Sural nerve courses into the lateral side of the foot where it becomes
the lateral dorsal cutaneous nerve of the foot.
271
Dorsalis Pedis At its distal end
, it is crossed by the tendon of the extensor hallucis brevis. The tendon of the extensor hallucis longus follows the artery distally along its medial side and the tendon of extensor digitorum longus can be located along its lateral aspect.
272
Sesamoid Bones - Second 2 most constant:
o No special name - within tendon of tibialis anterior – as it crosses smooth facet on medial cuneiform o os peroneum – within tendon of peroneus longus – as crosses the cuboid
273
Cuboid -Medial surface shape
o Quadrilateral shape
274
Extensor Digitorum Longus connot \_\_\_\_
It cannot extend the interphalangeal joints. The wing portion of the extensor hood is loose and the interphalangeal joints cannot be extended.
275
Cuboid -Lateral surface
o Smallest surface (more of a border)
276
Third Metatarsal -base -articular areas -Lateral Surface
• Oval, small facet (articulates with 4th metatarsal) • Groove [10a] – inferior to oval facet where there is an attachment: interosseous intermetatarsal ligament Note: the groove is a distinctive feature of this bone.
277
The extensor digitorum longus tendon of digits two, three, four and five - Tendons of the extensor digitorum brevis join
Tendons of the extensor digitorum brevis join the extensor digitorum longus at the level of the metatarsophalangeal joints on the fibular side just proximal to their division into three slips.
278
Talus -Articulates with medial malleolus
Articular facet (comma-shaped)
279
Extensor Expansions -They are similar to
to the extensor expansions of the fingers.
280
o 3 ligament attachments: 1) interosseous cuboideonavicular 2) interosseous cuneocuboid 3) calcaneocuboid portion of bifurcate ligament
Cuboid -Medial surface attachments
281
Inferior Extensor Retinaculum -The superolateral oblique band present in
about 25% of persons
282
Deep Peroneal Nerve lateral terminal
The lateral terminal branch passes deep to the extensor digitorum brevis and innervates it. It has three interosseous branches which serve the tarsal joints and the metatarsophalangeal joints of digits two, three and four. Also, a muscular branch from the 1st interosseous branch serves the second dorsal interosseous muscle
283
- Metatarsals o Each has 2 centers: Diaphysis (shaft) – appears during fetal life Epiphysis • 1st metatarsal (base) – appears
year 3
284
“M” Medial head of quadratus plantae attaches to
-medial surface (more extensive attachment than to medial process (plantar surface)) -Calcaneus -Medial Surface
285
Where are they attached? 1) dorsal cuneonavicular to medial cuneiform 2) dorsal cuneonavicular to intermediate cuneiform 3) dorsal cuneonavicular to lateral cuneiform 4) dorsal cuboideonavicular 5) dorsal talonavicular 6) calcaneonavicular portion of bifurcate ligament [29] 7) tibionavicular portion of deltoid ligament
Navicular dorsal surface
286
Intermediate Cuneiform -- Posterior Surface
-Triangular facet – articulates with navicular
287
Lateral Tarsal Artery
There are usually two tarsal arteries (medial and lateral) that arise from the dorsalis pedis while the latter is coursing over the tarsal bones. The lateral tarsal, often the largest branch of the dorsalis pedis, is usually a single branch that arises at the neck of the talus.
288
Medial Cuneiform -Lateral Surface - Shape and features
Concave 2 articular facets
289
Second Metatarsal -base -Lateral surface
-Two facets (1 dorsal & 1 plantar). A ridge of bone divides each facet into demarcates. • 2 anterior (1 dorsal & 1 plantar) – articulate with 3rd metatarsal {H} • 2 posterior (1 dorsal & 1 plantar) – articulates with lateral cuneiform {I}
290
Function of the Extensor Digitorum Longus
Acting alone, it tightens the sling and loosens the wing. When the muscle contracts the plantar plate is pulled against the metatarsal head resulting in extension (or hyperextension) of the metatarsophalangeal joints.
291
Calcaneus -Lateral Surface o Peroneal trochlea lies ....
anterior to the retrotrochlear eminence
292
Second Metatarsal -base -Plantar surface -Attachments:
• 1) long plantar ligament {M} • 2) tibialis posterior {N} • 3) adductor hallucis (oblique head) {O} • 4) plantar intermetatarsal ligament {P} • 5) plantar cuneometatarsal ligament {D}
293
Fourth Metatarsal - Base -Dorsal Surface
3 Ligament attachments • 1) dorsal intermetatarsal ligament (to 3rd metatarsal) {L} • 2) dorsal intermetatarsal ligament (to 5rd metatarsal) {L} • Dorsal cuboideometatarsal ligament {R}
294
Medial Cuneiform -Dorsal surface
apex of wedge, more of a crest/border than a surface often palpable subcutaneously
295
Navicular Plantar surface groove
o Groove for tibialis posterior – seperates navicular tuberosity from plantar surface – for continuation of the tendon of tibialis posterior beyond it’s attachment to the tuberosity
296
The medial marginal vein at the ankle (anterior to the medial malleolus) gives rise to
the great saphenous vein and the lateral marginal vein becomes the small saphenous vein posterior to the lateral malleolus.
297
Sulcus Tali
-Inferior surface of Talus -deep groove located at union of talus body and neck
298
If a second lateral tarsal artery is present, it often is
much smaller in size and originates while the dorsalis pedis is crossing over the intermediate cuneiform bone. If there are two lateral tarsals present, then they are known as the proximal and distal lateral tarsal arteries.
299
Cuboid o deep fibers of long plantar ligament attach
to the peroneal ridge
300
• Tarsal canal contains
the Interosseous talocalcaneal ligament
301
Extensor Digitorum Brevis Insertion
The extensor hallucis brevis inserts on the dorsal surface of the base of the proximal phalanx of the first digit. The other three tendons insert into the lateral surface of the tendons of the extensor digitorum longus muscle of the second, third and fourth digits, just distal to the metatarsophalangeal joints.
302
Cuboid -Inferior Surface (plantar surface) -located at point where medial and posterior borders meet
-Coronoid process “beak”
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First Metatarsal -head -On plantar surface
two sesamoid bone facets separated by small ridge (median crista)
304
Great Toe - Proximal Phalanx - Base
Directed Transvere, large Glenoid cavity – concave, oval articular surface Note: Cavity smaller than articulating metatarsal head
305
Second Metatarsal - Head
o Convex distally Note: consistent with all other metatarsals o Articular surface diverges in medial and lateral condyles (plantarly) Flexor tendons pass between these condyles
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Medial Cuneiform -Inverted L shaped facet
- Lateral surface -horizontal part superior, vertical part posterior – for intermediate cuneiform
307
cuboid tuberosity has
(termination of peroneal ridge) • Oval facet, overlying a sesamoid bone (os peroneum) in peroneus longus tendon
308
(dorsal) talonavicular ligament has what attachment
Superior surface of the neck of the talus
309
Talus - Body
o Superior surface- is called the Trochlea (because it is shaped like a pulley) -Convex from anterior to posterior
310
On occasion the lateral dorsal cutaneous nerve will give rise to or anastomoses with
the intermediate dorsal cutaneous nerve of the foot.
311
Fourth Metatarsal - Head
o Trochlear, convex shape - Plantar surface Groove for flexor tendons o Articulates with base of proximal phalanx Note: Head is similar to those of other metatarsals.
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Second Metatarsal - Shaft
o Three surfaces: dorsal, lateral, medial Note: consistent with 3rd and 4th metatarsals
313
Navicular
- Latin for “navy” – boat shaped, concave proximally, convex distally - Formerly known as “scaphoid bone”
314
After receiving the distal perforating arteries the dorsal metatarsal arteries are often known as
the common dorsal digital arteries.
315
Extensor expansions of the second, third, fourth and fifth digits
are similar . The extensor expansion of the hallux is different
316
The plantar metatarsal veins, while in the metatarsal spaces send perforating branches to
the dorsum of the foot and then unite to form the deep plantar venous arch
317
Extensor Expansions are formed
by the tendons of the extensor digitorum longus and brevis muscles
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-Formed by tendon of peroneus brevis
-Second groove of peroneal trochlea -Calcaneus -Lateral Surface
319
Sesamoid Bones - Most constant
within tendon of flexor hallucis brevis (1st MPJ joint) o Medial (tibial) – usually larger than lateral o Lateral (fibular)
320
Superfiical Peroneal Nerve
The superficial peroneal nerve, one of the two terminal branches of the common peroneal, arises deep to the peroneus longus muscle and passes inferiorly. It penetrates through the crural fasia of the leg and divides into its two terminal branches.
321
Nerves of Dorsum of Foot The Sural nerve --\>. The terminal part of the nerve courses
distally along the lateral side of the fifth toe where it is known as the 10th dorsal digital nerve.
322
What is the keystone of the lateral arch?
Although all weight is transferred only via the Talus, the cuboid is considered the Keystone
323
First Metatarsal -base--\>ligament attachments
o 2 ligament attachments 1) dorsal cuneometatarsal (medial surface) 2) plantar cuneometatarsal (inferior surface)
324
intermediate cuneiform -Random Facts
most typical (most similar to wedge shaped) + smallest of seven tarsal bones
325
Cuboid Peroneal sulcus (groove) & peroneal ridge
- both course obliquely, posterolateral -\> anteromedial.
326
Nerves of Dorsum of Foot Sural nerve
The sural nerve enters the foot inferior to the lateral malleolus. In the leg it follws the small saphenous vein
327
Talus - Head --\> Directed?
anteriorly, medially, and slightly inferiorly
328
Lateral Cuneiform -medial surface
o Rectangular in shape o Oval facet – Posteriorly, vertically orientated Articulates with intermediate cuneiform o Oval demarcates (x2) – Anteriorly Articulate with second metatarsal o One ligament attachment: 1) interosseous intercuneiform ligament
329
Dorsalis Pedis The course of the artery across the dorsum of the foot can be determined by
drawing a line from the middle of the transmalleolar line to the proximal part of the first intermetatarsal space. In about 10% of cases, the artery is either deviated to the medial or the lateral side. The usual diameter of the artery is about two or three millimeters, however, in about 5 – 10 % of individuals, it is much smaller in size and, therefore, difficult to locate.
330
Talus -Medial Surface
continuous with trochlea
331
Deep Veins of the Foot Inferior to the medial malleolus, the medial and lateral plantar veins unite to form
the posterior tibial veins.
332
Medial Cuneiform -Describe small facet near anteriorinferior aspect
• Small bursa lies between this facet and a sesamoid bone within tibailis anterior tendon
333
Inferior Extensor Retinaculum -The medial (deep) root attaches
The medial (deep) root attaches to the sulcus tali posterior to the attachment of the interosseous talocalcaneal ligament and may blend with it.
334
cuboid--\> posterior surface
o Triangular facet – articulates with calcaneus Saddle-shaped, concave transversely, convex vertically “side-ways saddle”
335
Muscles of the Dorsal Surface Extensor Digitorum Brevis origin
: Its origin is on a tubercle on the superolateral surface of the calcaneus just anterior to the sinus tarsi, from the interosseous talocalcaneal ligament and from the frondiform ligament.
336
Navicular- Posterior Surface
o Concave, - large oval/tear shaped facet Articulates with head of talus
337
Navicular Plantar surface attachments:
1) spring ligament (plantar calcaneonavicular) 2) plantar cuboideonavicular ligament 3) plantar cuneonavicular ligament to medial cuneiform 4) plantar cuneonavicular ligament to intermediate cuneiform 5) plantar cuneonavicular ligament to lateral cuneiform
338
Function of the Interosseous Muscles
there is agreement on the abduction/adduction functions of the interosseous muscles, there is some controversy about other functions. Some authors consider them to function as lumbricals, i.e. they extend the interphalangeal joints and flex the metatarsophalangeal joints. Other authors believe that their angles of pull are so poor for flexion of the metatarsophalangeal joints that they can only function in this capacity after the lumbricals have brought the joint into substantial flexion and have loosened the sling.
339
Fifth Metatarsal - Base
o Triangular/pyramidal in shape Apex (styloid process of fifth metatarsal) points – plantarly & laterally
340
Ossification of Foot Bones - Sesamoid bones
o Each has its own ossification center
341
Medial Cuneiform -Posterior surface -Facet Shape
like with the corresponding medial facet on the navicular, the shape of the facet can be triangular, pear-shaped or quadrilateral
342
Anterior surface of the Head of the Talus has
A large Ovoid, convex facet – articulates with navicular
343
Talus - Neck
o Constriction between body and head o Most visible on lateral and superior surfaces
344
Talus- posterior process -Medial tubercle has what attachments?
o 2 ligament attachments: 1. “M” Medial talocalcaneal “MR T.P.” 2. Posterior tibiotalar (part of deltoid ligment) o If present, medial band of posterior talocalcaneal lig. attaches here too
345
Lateral Cuneiform - Lateral Surface -facet
Triangular – posteriorly, largest – articulates with cuboid Oval – anteriorly, smaller – articulates with 4th metatarsal
346
Talus- posterior process
Bone ledge projecting posteriorly & inferiorly
347
Inferior Extensor Retinaculum is usually\_\_\_\_ but may have\_\_\_\_
The inferior extensor retinaculum (anterior ligament of the tarsus; ligamentum cruciatum of Weitbrecht; frondiform ligament of Retzius; ligamentum lambdoideum) is usually Y-shaped but may have an oblique superolateral band making it an X-shaped structure.
348
Navicular - Anterior Surface
o Convex side to side o Large articular facet – divided into 3 articular surfaces (for cuneiforms) by 2 vertical crests/ridges
349
Deep Plantar Artery penetrates the
the first dorsal interosseous muscle to reach the plantar side of the foot where it joins with the first plantar metatarsal artery of the deep plantar arch. Occasionally the first plantar metatarsal artery, instead of originating from the deep plantar arch, is a branch of or a direct continuation of the deep plantar artery.
350
Superficial Veins of the Foot The proper dorsal digital veins on the dorsum of the foot, after communicating with the proper plantar digital veins, unite to form
the dorsal metatarsal veins. These proceed to form the dorsal venous arch along the distal ends of the metatarsal bones.
351
Deep fibers of inferior peroneal retinaculum attach here
o Peroneal trochlea
352
Lateral Cuneiform -anterior surface
o Triangular facet – articulates with base of 3rd metatarsal
353
Intermediate Cuneiform -- Medial Surface
o Inverted “L” shaped articular facet (horizontal part superior, vertical part posterior – to match medial cuneiform “L”) o Non-articular area – for interosseous intercuneiform ligament (with medial cuneiform)
354
Second Metatarsal -base -Dorsal surface -Ligament attachments:
• dorsal intermetatarsal ligament (to third met) {L} • 1) dorsal cuneometatarsal ligament (to medial cuneiform) {C} • 2) dorsal cuneometatarsal ligament (to intermediate cuneiform) {C} • 3) dorsal cuneometatarsal ligament (to lateral cuneiform) {C}
355
Fifth Metatarsal - Base - Lateral surface
Tuberosity of fifth metatarsal – primary feature of lateral surface • Insertion: peroneus brevis {U}
356
- Metatarsals o Each has 2 centers: Diaphysis (shaft) – appears during fetal life Epiphysis • 2-5th metatarsals (head) – appears
years 5-8
357
First Metatarsal -Shaft
o Concave plantarly o Three surfaces: lateral, inferior (plantar), and dorsomedial
358
Lateral Cuneiform - Lateral Surface -ligament attachment
1) interosseous cuneocuboid ligament
359
two sets of veins in the foot
a superficial and a deep group.
360
The extensor digitorum longus tendon of digits two, three, four and five divides into
three slips
